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AB0366 Switching in 1st Anti-TNF Failures To 2nd Anti-TNF and or Alternative Biologic
  1. M. Sharif,
  2. D. Scott
  1. Rheumatology, King's college Hospital, London, United Kingdom


Background When patients fail 1st anti-TNF & continue to have high disease activity, clinicians face a choice of switching to 2nd anti-TNF or alternative biologic. We set out a study using real world data from a clinical cohort in secondary care hospital in the United Kingdom

Objectives To assess DAS response between the patients who have failed the 1st anti-TNF & compare switching to 2nd anti-TNF & or alternative biologic

Methods We undertook a retrospective, observational study using a routine care biologics database. RA was diagnosed by consultants based on ACR criteria. The patients who failed to respond to a first anti-TNF were selected (including primary & secondary non-responders). Patients were dichotomised into either those who received either 2nd anti-TNF & or an alternative biologics (rituximab, abatacept or tocilizumab). The primary outcome measure was DAS response at 6 months following at dose initiation. A secondary outcome was safety. Statistical analysis compared rates in 2 groups by using Fischer's exact test

Results 136 adult patients, who failed their 1st anti-TNF were included from January 2012 to December 2014. 56 (41.2%) patients received a 2nd anti-TNF & 13 (23.2%) had DAS non-response whereas 43 (76.8%) had DAS response. 19 patients failed second anti-TNF & had alternative biologic (including 6 with adverse events), whereas 37 continued. 99 (72.8%) received the alternative biologic in total. DAS response rates were 54%, 77% & 85% in the 3 groups. We further looked into the reasons for failure. Primary inefficacy was seen in 52 (38.2%), 23 (41%) & 38 (38.3%) patients in each of the cohorts respectively. Failure due to adverse events were seen in 24 (17.6%), 14 (25%) and 13 (13.1%) patients in each of the cohorts respectively. Secondary inefficacy was seen in 60 (44.1%), 19 (33.9%) & 48 (48.4%) patients. Further analysis of 61 patients of primary inefficacy, 23 patients received 2nd anti-TNF, 16 responded & 7 did not, 38 received alternative biologic, 35 responded & 3 did not. Fischer's exact test showed P-value of 0.032 for the patients on alternative biologic, which is statistically significant. The adverse events group had 27 patients, 14 received 2nd anti-TNF, 11 responded and 3 did not.13 patients received alternative biologic with DAS response. P-value was 0.222 which is statistically not significant. Out of 67 secondary inefficacy patients, 19 received 2nd anti-TNF, 16 responded and 3 did not. 48 patients received alternative biologic, 36 responded & 12 did not with P-value of 0.527.

Overall, when the responses were compared for primary inefficacy, adverse events & secondary inefficacy, 2nd anti-TNF group had a total response of 77% (70%, 79% & 84% respectively), whereas alternative biologic group had 85% (92%, 100% & 75% respectively).There were no observed differences in safety signal between any of the groups

Conclusions The study suggested that primary inefficacy patients respond better to alternative biologic, whereas 2nd anti-TNF group did not have statistically significant result. Adverse events group respond well to alternative biologics but the numbers were small. The disease duration and smoking status has shown to correlate with the biological treatment as well. Over all, this study should be repeated with large number of patients

  1. Annals of the Rheumatic Diseases.EULAR 2013 Spain

  2. Predictors of retention with abatacept in patients who failed one or more biologics Conference Abstract, September 2013

Acknowledgement Late Proffessor Kingsley

Disclosure of Interest None declared

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